Her health insurer gave her a fright

Monday

Aug 27, 2007 at 5:48 AMAug 27, 2007 at 8:38 AM

Insurance companies that provide health-care coverage should take one part of the classic Hippocratic Oath to heart: "... never do harm to anyone."

A Laconia woman's insurance company certainly caused her a great deal of needless anxiety when a day-and-a-half before breast cancer surgery she got the word that the company would not cover the cost of one aspect of the procedure.

To her credit, the woman, who certainly had enough on her mind already, decided to put up a stink. Lynn Sikowski called state officials, her senators in Washington and the media.

"Her insurance carrier has approved the procedure," Pauline Lamy of the state Insurance Commissioner's office said Thursday afternoon, 15 hours before she was scheduled to be wheeled into the operating room. "We called [the carrier] right away and went through the necessary procedures to get her the approval."

All health insurers have rules and regulations of what they will cover and what they will not, and assessing intricate health procedures can be a complicated task. In this particular case, Sikowski was not attempting to pull the right strings to get some kind of privileged treatment. She was ultimately approved for the full surgical procedure because it, in fact, met all the criteria for coverage.

"I am grateful and owe a lot of thanks to my doctor. ... I just don't want to see this happen to another woman in the future," Sikowski told The Citizen.

The issue of health insurance in this country continues to be an important plank in the nation's political debate.

Anecdotes like those experienced by Sikowski certainly do not help instill confidence in the present system.

Insurers could learn a valuable lesson from physicians. There are times when doctors have to deliver bad news to their patients and their families. But, as any competent doctor will tell you, there is a right way and a wrong way to deliver such news. Insurance companies should do their utmost to see that, when they have to deliver bad news with regard to coverage, they first make absolutely sure that their decision is, in fact, clearly called for and that they consider the plight and feeling of the patient in how they communicate that decision.